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Table 3 Comparison of features of a ‘components of care’ approach to NFR versus the ‘system of care’ approach captured in the Goals of Patient Care form in the hospital setting

From: Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making

‘Components of Care’ approach

‘Goals of patient care’ approach

Applies to small % of patients

Applies to large % of patients

Inconsistently records surrogate decision-maker and available advance care planning documents.

Routinely records surrogate decision-maker and availability of advance care planning documents.

Completed just before death, often by non-treating team

Proactively completed as part of routine care by treating team

Part of overall treatment plan, with 4 specific goals

Medical escalation plan outlining use of individual components of treatment

Medical escalation plan which is goal and system oriented

Associated with sub-optimal care

Associated with improved quality of care

Misses patient preferences

Seeks and records patients’ goals, values and preferences.

Sequential model of care with sharp demarcation from life prolonging care to palliative care

Introduces symptomatic palliative care earlier in illness trajectory

Hospital, time limited, medical treatment order (ie doctor to doctor communication)

Orders can be endorsed beyond the current admission (potential to be an ongoing advance care plan)